Instant Fee Comparison: The Standard Dental Insurance Approach Vs. Discount Dental Services


Is the standard dental insurance that's available to individuals worth purchasing?

The mere fact that only 55% of this country's residents have dental coverage but that well over 90% of those plans are paid for by an employer or union is telling: (Continued After Table...)


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CATEGORY DESCRIPTIONS FEES METRO AREA STATE
DIAGNOSTIC D0120 Periodic oral evaluation $33 National Sample NA
DIAGNOSTIC D0150 Comprehensive oral evaluation $53 National Sample NA
DIAGNOSTIC D0274 X-Ray: Bitewings-4 films $49 National Sample NA
PREVENTIVE D1110 Prophylaxis-adult $58 National Sample NA
RESTORATIVE D2140 Amalgam filling-1 surface, primary or permanent $88 National Sample NA
RESTORATIVE D2330 Resin-based filling composite 1 surface, anterior $108 National Sample NA
RESTORATIVE D2750 Crown-porcelain fused to high noble metal $760 National Sample NA
ENDODONTICS D3330 Molar (excluding final restoration) $780 National Sample NA
PERIODONTICS D4341 Periodontal scaling and root planing, 4 or more teeth, per quad. $181 National Sample NA
PROSTHODONTICS D5110 Complete denture-maxillary $850 National Sample NA


(...Continued From Above)
We like others to pay for our dental benefits. Yet, more insurers and discount networks are offering individual versions of the standard dental insurance and dental discount plans offered to employers. The big question is, does purchasing an individual standard dental insurance plan make sense?

The Math Behind Standard Dental Insurance?

While fees for standard dental insurance for the individual vary, a conservative monthly figure for true dental insurance (not a discount dental "insurance" plan which has no "risk protection" built into it but rather a discount on payments) would be $70 per month. (Even small business group dental insurance plans can be up to $150 per month for individuals, so this figure is a resonable starting point.) This means that the total cost of the standard dental insurance plan used in this model would be $940 per year.
Next, consider what is called a co-payment ("co-pay"). This is typically rated at 50% of the cost of the treatment. If a procedure like a crown costs $1,000, then the patient must pay $500 of the fee. Co-pay on most individual plans runs at least 50% on treatments. (Don't be confused with having no co-pays for preventative care which includes exams, cleanings and X-rays, which are relatively low cost. Some plans also have a "deductible" which is generally a smaller amount, such as $50, although the terms deductible and co-pay are sometimes (incorrectly) used interchangeably. Finally, a plan maximum is the most a plan will pay for a procedure in a calendar year. This amount is typically around $1,000.

Under the above example, if the plan had a 12 month waiting period before allowing you to receive treatment (which many do) you would have paid nearly $1,000 in premiums and gotten only $1,000 in treatment. True, there would have been "free" exams, X-rays and cleanings, but if for some reason you didn't use %100 percent of your benefit, you would very likely have paid more in than received. Also, if you needed more work than the $1,000 plan maximum, you would be paying at 100% of the charged fee.

Admittedly an employer-paid (or in most cases subsidized since the employee pays part of this) large, medium or even small business dental insurance plan can be a better situation since the employer pays at least some of the premium (although these contributions are getting smaller as time goes on as well).

The bottom line is:

1.Figure out how much you really are benefitting from the standard dental insurance policy you get.

2. Decide how much you will use the plan, since you can end up paying for something you don't use if you are not certain of needing treatment.

3. Realize the reimbursement/payout limitations of the plan, particularly if it has a waiting period.

4. Consider alternatives such as discount dental products which provide similar fee reductions as standard dental insurance, but are only really used when needed. The table below represents typical discounts available from these type of programs verus the standard type dental insurance.